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ESPVR Contractility — FRCA Primary MCQ

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HardPhysiology - CardiovascularESPVR ContractilityFRCA Primary

During transient inferior-vena-cava occlusion, a series of left-ventricular pressure–volume loops is obtained. Dobutamine is then commenced. Which change most strongly indicates increased contractility?

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Correct answer: C — A steeper end-systolic pressure–volume relationship

The best answer is “A steeper end-systolic pressure–volume relationship”. The slope of the end-systolic pressure–volume relationship is end-systolic elastance, a relatively load-independent marker of contractility. Positive inotropy steepens and generally shifts this relation leftward/upward, reducing end-systolic volume for a given pressure. A steeper end-diastolic relation instead indicates reduced ventricular compliance; loop area reflects stroke work, not a specific contractility index.

Reference: RCoA, Primary FRCA syllabus: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf; Invasive left-ventricle pressure–volume analysis: https://pmc.ncbi.nlm.nih.gov/articles/PMC7084193/